Download PDF
Thromb Haemost 1995; 73(02): 180-185
DOI: 10.1055/s-0038-1653748
Original Article
Clinical Studies
Schattauer GmbH Stuttgart

Urokinase Therapy in Neonates with Catheter Related Central Venous Thrombosis

M L G Wever
The Department of Pediatrics, University Hospital Nijmegen, The Netherlands
,
K D Liem
The Department of Pediatrics, University Hospital Nijmegen, The Netherlands
,
W B Geven
The Department of Pediatrics, University Hospital Nijmegen, The Netherlands
,
R B Tanke
The Department of Pediatrics, University Hospital Nijmegen, The Netherlands
› Author Affiliations
Further Information

Publication History

Received 15 March 1994

Accepted after resubmission 18 October 1994

Publication Date:
26 July 2018 (online)

  PDF Download  Permissions and Reprints

Summary

The results of fibrinolytic therapy with urokinase were evaluated in 26 neonates with catheter related central venous thrombosis. Complete thrombolysis could be achieved in 13 patients (50%), partial thrombolysis in 3 patients (12%). No effect was seen in 10 patients (38%). Therapy success was influenced by age, size and location of the thrombus. Coincidence of infection occurred in 16 patients (62%). Mild hemorrhagic complications were seen in 2 patients (8%), no other significant side effects were observed. Nine patients with residual thrombosis were treated with oral anticoagulants following urokinase resulting in resolution of the thrombus in 6 patients within 3 months (67%). The incidence of asymptomatic recurrent thrombosis was high (28%). Urokinase might be an effective and safe treatment for central venous thrombosis in neonates. Prophylactic antibiotic therapy during the infusion of urokinase and long-term treatment with oral anticoagulants after thrombosis are advisable. Early detection of thrombosis might enhance the success rate of fibrinolytic therapy. Therefore, we strongly recommend routine echocardiographic screening of central venous catheters.

 

  • References

  • 1 Ryan JA, Abel RM, Abbott WM, Hopkins CC, Chesney TM, Colley R, Phillips K, Fischer JE. Catheter complications in total parenteral nutrition. N Engl J Med 1974; 290: 757-761
    CrossrefPubMedGoogle Scholar
  • 2 Grisoni ER, Mehta SK, Connors AF. Thrombosis and infection complicating central venous catheterization in neonates. J Pediatr Surg 1986; 21: 772-776
    CrossrefPubMedGoogle Scholar
  • 3 Mactier H, Alroomi LG, Young DG, Raine PA M. Central venous catheterisation in very low birthweight infants. Arch Dis Child 1986; 61: 449-453
    CrossrefPubMedGoogle Scholar
  • 4 Marsh D, Wilkerson SA, Cook LN, Pietsch JB. Right atrial thrombus formation screening using two-dimensional echocardiograms in neonates with central venous catheters. Pediatrics 1988; 81: 284-286
    PubMedGoogle Scholar
  • 5 Mendoza GJ B, Soto A, Brown EG, Dolgin SE, Steinfeld L, Sweet AY. Intracardiac thrombi complicating central total parenteral nutrition: Resolution without surgery or thrombolysis. J Pediatr 1986; 108: 610-613
    CrossrefPubMedGoogle Scholar
  • 6 Corrigan JJ. Neonatal thrombosis and the thrombolytic system: pathophysiology and therapy. Am J Pediatr Hematol Oncol 1988; 10: 83-91
    CrossrefPubMedGoogle Scholar
  • 7 O’Neill JA, Neblett WW, Bom ML. Management of major thromboembolic complications of umbilical artery catheters. J Pediatr Surg 1981; 16: 972-978
    CrossrefPubMedGoogle Scholar
  • 8 Schmidt B, Andrew M. Neonatal thrombosis: a critical appraisal of the available evidence on prevention, diagnosis, and treatment. In: Perinatal Thrombosis and Hemostasis. Suzuki S, Hathaway WE, Bonnar J, Sutor AH. eds. Springer-Verlag; Tokyo: 1991. pp 137-144
    Google Scholar
  • 9 Corrigan JJ, Sleeth JJ, Jeter M, Lox CD. Newborn’s fibrinolytic mechanism: components and plasmin generation. Am J Hematol 1999; 32: 273-278
    PubMedGoogle Scholar
  • 10 Bell WR, Meek AG. Guidelines for the use of thrombolytic agents. N Engl J Med 1979; 301: 1266-1270
    CrossrefPubMedGoogle Scholar
  • 11 The Urokinase Pulmonary Embolism Trial: A National Cooperative Study. American Heart Association Monograph, No. 39. Circulation 1973; 47 Suppl (Suppl. 02) 7-23
    PubMedGoogle Scholar
  • 12 Delaplane D, Scott JP, Riggs TW, Siverman BL, Hunt CE. Urokinase therapy for a catheter-related right atrial thrombus. J Pediatr 1992; 100: 149-152
    PubMedGoogle Scholar
  • 13 Cumow A, Idowu J, Behrens E, Toomey F, Georgeson K. Urokinase therapy for silastic catheter-induced intravascular thrombi in infants and children. Arch Surg 1995; 120: 1237-1240
    PubMedGoogle Scholar
  • 14 Zureikat GY, Martin GR, Silverman NH, Newth CJ L. Urokinase therapy for a catheter-related right atrial thrombus and pulmonary embolism in a 2-month-old infant. Pediatr Pulmonol 1986; 2: 303-306
    CrossrefPubMedGoogle Scholar
  • 15 Pongiglione G, Marasini M, Ribaldone D, Silvestri G, Tuo P, Garello-Cantoni L. Right atrial thrombosis in two premature infants: successful treatment with urokinase and heparin. Eur Heart J 1986; 7: 1086-1089
    CrossrefPubMedGoogle Scholar
  • 16 Sadiq HF, Devaskar S, Keenan WJ, Weber TR. Broviac catheterization in low birth weight infants: incidence and treatment of associated complications. Crit Care Med 1997; 15: 47-50
    PubMedGoogle Scholar
  • 17 Wilson CM, Merritt RJ, Thomas DW. Successful treatment of superior cava syndrome with urokinase in an infant. J Parenter Enteral Nutr 1988; 12: 81-83
    CrossrefPubMedGoogle Scholar
  • 18 Griffin MP, Casta A. Successful urokinase therapy for superior vena cava syndrome in a premature infant. Am J Dis Child 1988; 142: 1267-1268
    PubMedGoogle Scholar
  • 19 Caglar MK, Tolboom J. Successful treatment of superior vena cava syndrome with urokinase in an infant with a central venous catheter. HelvPaediat Acta 1988; 43: 483-486
    PubMedGoogle Scholar
  • 20 Valk WJ C, Liem KD, Geven WB. The Seldinger technique as an alternative approach for the percutaneous insertion of a hydrophilic poly-urethane central venous catheter in the newborn. JPEN. 1995 (accepted)
    PubMedGoogle Scholar
  • 21 Schmidt B, Andrew M. Report of scientific and standardization subcommittee on neonatal hemostasis: diagnosis and treatment of neonatal thrombosis. Thromb Haemost 1992; 67 (03) 381-382
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Mollitt DL, Golladay ES. Complications of TPN catheter induced vena caval thrombosis in children less than one year of age. J Pediatr Surg 1993; 18: 462-466
    PubMedGoogle Scholar
  • 23 Gauderer MW, Stellato TA. Subclavian Broviac in children - technical considerations in 146 consecutive placements. J Pediatr Surg 1985; 20: 402-405
    CrossrefPubMedGoogle Scholar
  • 24 Haddad W, Idowu J, Georgeson K, Bailey L, Doroshow R, Pickham N. Septic atrial thrombosis: a potentially lethal complication of Broviac catheters in infants. Am J Dis Child 1986; 140: 778-781
    CrossrefPubMedGoogle Scholar
  • 25 Haar RL, Miller CA. Hydrocephalus resulting from superior vena caval thrombosis in an infant. J Neurosurg 1975; 42: 596-601
    PubMedGoogle Scholar
  • 26 Kramer SS, Taylor GA, Garfinkel DJ, Simmons MA. Lethal chylothoraces due to superior vena caval thrombosis in infants. Am J Radiology 1991; 137: 559-563
    PubMedGoogle Scholar
  • 27 Mahoney L, Snider AR, Silverman NH. Echocardiographie diagnosis of intracardiac thrombi complicating total parenteral nutrition. J Pediatr 1991; 98: 469-471
    PubMedGoogle Scholar
  • 28 Goldberg SJ, Allen HD, Sahn DJ. Pediatric and adolescent echocardiography; a handbook. Year Book Medical Publishers; Chicago: 1975. pp 3-11
    Google Scholar
  • 29 Marder VJ, Sherry S. Thrombolytic therapy: current status. N Engl J Med 1988; 318: 1512-1520 (part one)
    CrossrefPubMedGoogle Scholar
  • 30 Marder VJ, Sherry S. Thrombolytic therapy: current status. N Engl J Med 1988; 318: 1585-1595 (part two)
    CrossrefPubMedGoogle Scholar
  • 31 Anderson BJ, Keeley SR, Johnson ND. Caval thrombolysis in neonates using low doses of recombinant human tissue-type plasminogen activator. Anaesth Intensive Care 1991; 19: 22-27
    PubMedGoogle Scholar
  • 32 ISIS-3. A randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41299 cases of suspected acute myocardial infarction. Lancet 1992; 339: 753-770
    CrossrefPubMedGoogle Scholar
  • 33 Seigel EL, Jew AC, Delcore R, Iliopoulos JI, Thomas JH. Thrombolytic therapy for catheter-related thrombosis. Am J Surg 1993; 166: 716-718
    CrossrefPubMedGoogle Scholar
  • 34 Ekelund H, Hedner U, Nilsson IM. Fibrinolysis in newborns. Acta Paediatr Scand 1990; 59: 33-43
    PubMedGoogle Scholar
  • 35 Andrew M, Brooker L, Leaker M, Paes B, Weitz J. Fibrin clot lysis by thrombolytic agents is impaired in newborns due to a low plasminogen concentration. Thromb Haemost 1992; 68: 325-330
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Edelberg JM, Enghild JJ, Pizzo SV, Gonzalez-Gronow M. Neonatal plasminogen displays altered cell surface binding and activation kinetics. J Clin Invest 1990; 86: 107-112
    CrossrefPubMedGoogle Scholar
  • 37 Schmidt B, Zipursky A. Thrombotic disease in newborn infants. Clin perinatal 1984; 11: 461-488
    CrossrefPubMedGoogle Scholar
  • 38 Vailas GN, Brouillette RT, Scott JP, Shkolnik A, Conway J, Wiringa K. Neonatal aortic thrombosis: recent experience. J Pediatr 1986; 109: 101-108
    CrossrefPubMedGoogle Scholar
  • 39 Strife JL, Ball WS, Towbin R, Keller MS, Dillon T. Arterial occlusions in neonates: use of fibrinolytic therapy. Radiology 1988; 166: 395-400
    CrossrefPubMedGoogle Scholar
  • 40 Rajani K, Goetzman BW, Wennberg RP, Turner E, Abildgaard C. Effect of heparinization in fluids infused through an umbilical artery catheter on catheter patency and frequency of complications. Pediatrics 1979; 63: 552-556
    PubMedGoogle Scholar
  • 41 Schmidt B. Neonatal thrombotic disease: prevention, diagnosis and treatment. J Pediatr 1998; 113: 407-410
    PubMedGoogle Scholar
  • 42 Borow M, Crowley JG. Evaluation of central venous catheter thrombogen-icity. Acta Anaesthesiol Scand 1985; Suppl 81: 59-64
    PubMedGoogle Scholar
  • 43 Jackson JC, Truog WE, Watchko JF, Mack LA, Cyr DR, van Belle G. Efficacy of thromboresistant umbilical artery catheters in reducing aortic thrombosis and related complications. J Pediatr 1997; 110: 102-105
    PubMedGoogle Scholar